FY2027
MenuClose
Excludes1 pair

P93- vs P96.1

P93 and P96.1 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported. The distinction is perinatal vs later onset.

The official note, declared on P93
withdrawal symptoms from maternal use of drugs of addiction (P96.1)
P93

Reactions and intoxications due to drugs administered to newborn

Not billable
Chapter 16
Certain conditions originating in the perinatal period
Section
P90-P96
Use when the record says
  • reactions and intoxications due to drugs administered to fetus affecting newborn
P96.1

Neonatal withdrawal symptoms from maternal use of drugs of addiction

Billable
Chapter 16
Certain conditions originating in the perinatal period
Section
P90-P96
Use when the record says
  • Drug withdrawal syndrome in infant of dependent mother
  • Neonatal abstinence syndrome
Indexed under
  • Abstinence symptoms, syndrome › neonatal
  • Newborn › abstinence syndrome
  • Syndrome › abstinence, neonatal
  • Syndrome › drug withdrawal, infant of dependent mother
  • Syndrome › neonatal abstinence

Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027